Im trying to help a friend out, and she is really really upset.

Basically, she was born with a cleft lip and palette, and had lots of operations as a child. There are however, about 3 operations she should have had around the 16/17 age mark, but because of one thing and another (being put into foster care, gsce's, college etc) and because her social worker dropped her, she didnt get them done.

Basically, she is having problems, because the fact that she needs this surgery doing is depressing her, but when she approaches her GP, they just say 'go and see a phsychiatrist'. If she had the surgery she wouldnt need the shrink.

Partly what i think is going on is that her appearance has got her so down, the docs are taking the mental health route, rather than the surgery route.

Does anyone know how you would go about getting back on the lists for surgery that should have been done several years ago, without having to have grief from a GP?

I know some people might think that seeing some counsellors would help, but ive been there, and in all honesty, it wont (i have known this person 14 years, so more than half my life, i know her almost as well as i know myself, and i know first hand how off putting and thoroughly useless the front line of mental health care can be.)

Em

if she does see the phsychiatrist he can refer her for the surgery as he can show that the surgery would be of benefit to her mental health.

I think she will really have to explore that route first as they are reluctant to perform surgery.

Unless she can afford to go private!!

Hiya,

Yeah, ive got a horrible feeling that thats gonna be the case, which is a pain, i know how long it took me to get an appt with a pyschiatrist, and most of them dont have an exactly pleasant bedside manner....she has got so upset by the unthinking comments doctors and other healthcare proffessionals have made that she doesnt want to leave the house!

Sadly, private healthcare is beyond her means (doesnt it suck that if you are rich, you can just go and get it done, if you arent you get ripped to peices!)

There is no question that she needs this surgery, its just i think, a case of asking the right people the right questions, something ive found isnt easy to do!

Em

Sadly it is the people who need to be forceful and persistent who are unable to be so, she could try her local PM but if she has been offered a consultation with a psychiatrist perhaps she should follow that line. May be with her permission you could write to her doctor saying how worried you are about her, they may take no notice but if she has no family then I would think you have the right to try and help and support her.

I am sorry to hear about the difficulties your friend is facing, and has had to face through all of her life.  It's so good that she has the support of someone she can rely on and trust and I am sure she values your friendship.

Seeing a psychiatrist may not be quite as bad as it seems and is not the same thing at all as 'seeing a counsellor'.  A psychiatrist will be able to assess how her depression is affected by her appearance, and will be able to support her in arranging the necessary surgery.  It will be important that her depression is addressed as this will affect her recovery time and it may be that she has a particular aim in mind that may not be realistic for some time after surgery.  She will need support to adjust to exactly what is happening at the moment and to carry her forward into the next stages of her treatment.

Initially, I would suggest she change her GP.  If it is the case that he hasn't explained the role of the psychiatrist in her care, then he is negligent.  She is not expected to see a psychiatrist because she is seen as mentally disturbed.  Cleft lip and palate is the 4th most common birth defect and it may be that her perception of what people are thinking about her is not what they actually do think. 

Lots of people from all walks of life from supermodels to Joe Bloggs seek psychiatric support and her appearance will not be the sole source of difficulties in her life.  You mention the other difficulties she has had and the fact that she feels "dropped" by her social worker will have had a tremendous impact on the way she views things.  It may be that the psychiatric team will suggest CBT. Cognitive therapy is a way of talking about the connections between how we think, how we feel and how we behave. It particularly concentrates on ideas that are unrealistic. These often undermine our self-confidence and make us feel depressed or anxious. Looking at these can help us work out different ways of thinking and behaving that in turn will help us cope better. 

Your friend has a lot to cope with and I am sure she will get through with such a good friend as yourself.  Please support her in accepting the suggestion of psychiatric help, go with her and write things down for her, ask the questions for her.  Help her discuss the plans for her surgery and her future.

There are lots of organisations that can also give her support and a quick search of Google will find you quite a few.  CLAPA is the Cleft Lip and Palate Association and they have a branch espcially for adults.  Changing Faces can also provide good sources of help.  Perhaps a quick chat with one of these organisations would set your mind at rest.

Good Luck.
Jacky

Hi

I am sorry to hear that your friend is feeling this way.  You sound like a great friend to her .  IMO I would firstly speak to the practice manager of her doctors and see what they have to say, other places I would try would be the FHSA, procedures dept at local hospital, or consultants secratary.  If she feels strongly against seeing a Psychiatrist and this would cause more upset then I would suggest trying other avenues first.  If all else fails she could change GP.  I did this when my last GP was no help at all wirth my condition and my new GP has been a star.
I hope your friend can work through this difficult time with your help and support and gets the treatment she deserves.

Good luck

Michelle :)

Hiya,

thanks for all the advice. :)

im going to pass on stuff to my  mate, and also ive hunted down a friendly GP (friend of my mums) who i shall grill for answers.

Em

My GP has always been excellent with regards to my daughters care but a consultant at the childrens hospital was a total pratt!
After chatting to someone with similar symptoms to maisie she advised me to contact her consultant in Bristol and i did via email and we got an appointment (no referal or anything).
So maybe if you write to the hospital they may take it up? Otherwise i would think about changing gp's.

I totally agree with going to see another GP although would still encourage the young lady to seek support for the other difficulties she faces, including depression from the psychiatric referral.  The psych team will be the best place to get the up-to-date treatment. medication etc most relevant to her with a much better idea than the GP will have.  It's going to be a really important part of her all round care, well-being and recovery.  She's seems to have had a difficult time which probably won't be "cured" with surgery but needs a holistic approach.

Em, I see someone has already mentioned CLAPA (Cleft lip and palate association)  They can probably give some idea of what could be done.  A GP should refer to a plastic surgeon for a complete review of possible further surgery, should your friend need any more.
Lorna

Hiya,

With some encouragement, she now has the phone number and email address of the local CLAPA person/adviser wotever....and is going to contact them.

Im not entirely certain whats happened, but from her boyfriend (also a very good close friend of mine) i gather someone at her work said something nasty to her about her face. Then, the same day someone in the street said something nasty, she wasnt feeling too good anyway, and since then she struggles to go out on her own, or talk to people she doesnt know.

Previous to this she has been a very remarkably strong person, she knows whats the surgery entails, and from mine and various other peoples experiences with mental health teams, considering just how long it takes before you get to talk to someone who actually makes sense, i dont think thats the route to go down just now, although im trying to keep her mind open about it for the future.

Hopefully we can get this sorted for her, it hurts so much to see such a strong person cowed by the narrow minded and thoughtless comments of a few.

Cheers :)

Em

Bloody ignorant people get on my nerves!! My daughter was in serial casting (plaster casts) on her legs for months and in a supermarket a woman said to her child "thats what happens when you're naughty" My reply is unprintable here.
Tell her best of luck :)